Precision Nursing for Acute Ischemic Stroke Survival: Exploring the Low‐Density Lipoprotein Cholesterol Lipid Paradox

Aims To identify the predictors of in‐hospital survival in patients with acute ischemic stroke and to examine the association between low‐density lipoprotein cholesterol levels and in‐hospital mortality, thereby providing a basis for precision nursing strategies. Design A retrospective observational study. Methods Data were analysed from 2733 patients with acute ischemic stroke admitted to a regional hospital between 2019 and 2023. Variables included demographics, comorbidities, physical examinations, biochemical indicators and symptom‐to‐door time (SDT). Stroke severity was assessed using the National Institutes of Health Stroke Scale. Survival was defined by the modified Rankin Scale at discharge, where scores of zero to five represented survival and a score of six represented death. Multivariable logistic regression was used to identify independent predictors of survival, adjusting for nine covariates including gender, age and lipid profiles. Results The analysis identified female gender, age 65 years or older, history of heart disease, smoking habits and low‐density lipoprotein cholesterol levels as significant independent predictors of survival. Specifically, female patients, older adults, those with heart disease and smokers faced a significantly higher risk of mortality. Notably, very low levels of low‐density lipoprotein cholesterol (< 70 mg/dL) were associated with a substantially higher risk of death compared to patients with moderate or high levels, highlighting a lipid paradox where lower cholesterol values at admission predicted poorer survival. Conclusion There is a paradoxical relationship between low‐density lipoprotein cholesterol and survival; extremely low levels significantly increase mortality risk, potentially reflecting poor physiological reserve or malnutrition. Crucially, stroke nurses and Clinical Nurse Specialists should not misinterpret low admission LDL‐C as clinical resilience. Instead, paradoxical hypocholesterolemia serves as a critical marker of occult nutritional frailty and physiological exhaustion. Integrating baseline lipid profiles into routine nursing assessments enables early identification of vulnerable patients and proactive surveillance, generating key hypotheses for future prospective trials to evaluate targeted precision‐nursing and nutritional interventions. Patient or Public Contribution No Patient or Public Contribution.